17.3.1: Sleep

Learning Objectives

1. Identify the recommended amount of sleep for school-age children.
2. Explain the role of sleep in physical and cognitive development.
3. Describe strategies that support healthy sleep habits and routines in middle childhood.
4. Explain the causes, types, and treatments of nocturnal enuresis, and recognize the importance of a supportive response.

School-age children typically need between 9 and 12 hours of sleep per night to support optimal health and development (Paruthi et al., 2016). This recommendation reflects not only the body's need for physical rest but also the brain’s need for consolidation of learning and development. However, many children in this age group do not consistently get the recommended amount of sleep due to busy schedules, excessive screen time, or poor sleep habits.

Encouraging Quality Sleep

Several strategies can help promote healthy sleep patterns in school-age children. A consistent bedtime and wake time, even on weekends, helps regulate the circadian rhythm. Creating a bedtime routine that includes calming activities, such as reading or listening to soft music, can signal to the brain that it's time to wind down. The sleep environment should be quiet and dark, with limited screen exposure before bedtime. Research suggests that exposure to blue light from tablets and televisions can delay the release of melatonin, making it harder for children to fall asleep (Hale & Guan, 2015).

Figure \(\PageIndex{1}\). A young girl uses her tablet before going to bed. Image by cottonbro studio licensed by Pexels.

Physical activity during the day also contributes to better sleep quality, though vigorous activity right before bedtime should be avoided. Dietary habits can also play a role; consuming large meals or caffeine too close to bedtime can interfere with the ability to fall or stay asleep.

Consequences of Poor Sleep

Insufficient or poor-quality sleep in middle childhood is associated with a range of negative outcomes. Sleep deprivation has been linked to difficulties with attention, memory, and executive functioning, which can in turn affect academic achievement (Astill et al., 2012). It may also lead to behavioral problems such as irritability, hyperactivity, and emotional dysregulation, often mimicking symptoms of attention-deficit/hyperactivity disorder (Beebe, 2011).

In addition to cognitive and behavioral issues, chronic sleep deprivation can impact physical health. It may weaken the immune system, disrupt growth hormone secretion, and increase the risk for obesity, as tired children are more likely to be sedentary and overeat (Taheri et al., 2004). The compounding effects of inadequate sleep may also influence social development, as tired children are more likely to struggle with peer relationships and social problem-solving.

Nocturnal Enuresis

One common sleep-related concern is nocturnal enuresis, also known as bedwetting. This condition is defined as involuntary urination during sleep in children over the age of five. It can be categorized as primary (when the child has never achieved consistent nighttime dryness) or secondary (when bedwetting reoccurs after a period of dryness). It affects an estimated 5–10% of 7-year-olds, with prevalence decreasing with age (Nevéus et al., 2010).

Nocturnal enuresis can result from a combination of factors, including delayed bladder control, deep sleep patterns, reduced nighttime production of antidiuretic hormone (ADH), or a genetic predisposition. Emotional stress, such as parental divorce or school transitions, may also contribute to secondary enuresis.

While not typically harmful from a physical health perspective, bedwetting can lead to significant embarrassment and distress for children. Encouraging a supportive and non-punitive approach is essential. Treatments may include behavioral strategies (such as scheduled nighttime waking or bladder training), moisture alarms, and in some cases, medication (e.g., desmopressin). It is important for families and educators to understand that enuresis is not a child’s fault and that most children outgrow it with time and support.

References, Contributors and Attributions

^{Astill, R. G., Van der Heijden, K. B., Van IJzendoorn, M. H., & Van Someren, E. J. (2012). Sleep, cognition, and behavioral problems in school-age children: A century of research meta-analyzed. Psychological Bulletin, 138(6), 1109–1138. https://doi.org/10.1037/a0028204}

^{Beebe, D. W. (2011). Cognitive, behavioral, and functional consequences of inadequate sleep in children and adolescents. Pediatric Clinics, 58(3), 649–665. https://doi.org/10.1016/j.pcl.2011.03.002}

^{Hale, L., & Guan, S. (2015). Screen time and sleep among school-aged children and adolescents: A systematic literature review. Sleep Health, 1(4), 214–221. https://doi.org/10.1016/j.sleh.2015.08.007}

^{Nevéus, T., von Gontard, A., Hoebeke, P., Hjalmas, K., Bauer, S., Bower, W., ... & Djurhuus, J. C. (2010). The standardization of terminology of lower urinary tract function in children and adolescents: Report from the Standardisation Committee of the International Children’s Continence Society. The Journal of Urology, 183(4), 1297–1302. https://doi.org/10.1016/j.juro.2009.12.045}

^{Paruthi, S., Brooks, L. J., D’Ambrosio, C., Hall, W. A., Kotagal, S., Lloyd, R. M., ... & Wise, M. S. (2016). Consensus statement of the American Academy of Sleep Medicine on the recommended amount of sleep for healthy children: Methodology and discussion. Journal of Clinical Sleep Medicine, 12(11), 1549–1561. https://doi.org/10.5664/jcsm.6288}

^{Taheri, S., Lin, L., Austin, D., Young, T., & Mignot, E. (2004). Short sleep duration is associated with reduced leptin, elevated ghrelin, and increased body mass index. PLoS Medicine, 1(3), e62. https://doi.org/10.1371/journal.pmed.0010062}